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GALL STONE DISEASE IN OBESITY There is higher incidence of gall stones disease in obese people as compared to general population BMI > 40 RR ratio 5-6 times of that background population Almost always cholesterol stones Lapbariatric surgery 2005(36)

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Management I.The most aggressive is the concomitant cholecystectomy for all patients this prevents the potential complication of future gallstones and a second surgery, Recent reports shows no significant increase in-- morbidity It may reduce cost Poor sensitivity of USG in obese people Biliary causes may be difficult to diagnose after RYGB

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procedure specific risk RYGB Rapid weight loss Median likelihood of forming new gallstones is 40% High incidence of new gall stones development after surgery No option of routine ERCP 40% of these have symptomatic disease 70 % failure of full compliance with preventive ursodiol tr. paul obrien arch surg.2003;138

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procedure specific risk GASTRIC BAND Only 6.8 % at risk of syptomatic disease at a median follow up of 42 months paul obrien arch surg.2003;138

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Factors to consider Surgical approach is also relevant. Open & laparoscopic Additional time 30 – 50 mts of operating time Length of stay increased from 2.7 days to 4.4 days Potential for the full range of complications that may occur with cholecystectomy paul obrien arch surg.2003;138

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Preventive measures Ursodeoxycholic acid Control of weight loss Reduction of length of overnight fast period maintenance of small amount of fat in the diet Eur j gastroenterol 2000dec12(12) Haptology 1996sep;544

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In formulating policy regarding the investigations & management of the gallbladder in obesity we must incorporate recognition of the likelihood of disease in the future & the health consequences of that disease balanced against the cost & risk of the treatment conclusions

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CONCLUSIONS There is significantly increased risk of gallstone disease in obese people compared with that in the general population. There are different approaches for managment the type of bariatric procedure chosen affects these approaches Prospective randomized trials about these approaches needed to determine superiority.